Organization · Type 2 NPI

State of New York

Intellectual Disabilities Intermediate Care Facility · Queens Village, NY

NPI number 1356930820 Active

Practice location

8045 Winchester Blvd Bldg 8
Queens Village, NY 11427-2194

Call (718) 217-5767 Map

Mailing address

44 Holland Ave
Albany, NY 12208-3411

Specialties and licenses

Taxonomy	Code	License
Intellectual Disabilities Intermediate Care Facility Primary	315P00000X	None listed

Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.

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NPI record

NPI: 1356930820
Entity type: Organization (Type 2)
Issued: Jan 11, 2021
Last updated: Jan 11, 2021
Status: Active
Subpart: Yes of State of New York Comptrollers Office

Other names

Bernard M. Fineson Developmental Disabilities Services Office · other name

Authorized official

Earl Raymond Jefferson
Director of Central Operations
(518) 402-4333

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1356930820

State of New York's National Provider Identifier is 1356930820, issued on Jan 11, 2021. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Queens Village, NY. The record was last updated on Jan 11, 2021.